Allscripts — Stabilize, then Proceed with Innovation

At the recent Allscripts Client Experience (ACE, #ACEHHS18) conference, the company gave us a day and a half deep dive into their current strategy and initiatives. As much as Allscripts positioned themselves as the innovative leader among the leading EHR vendors, the fundamental reality was far simpler. This is a company that is seeking to stabilize its base, and that is a good thing.

Figure 1: Allscripts’ Advances in the Last Five Years

As most readers know, when CEO Paul Black took over the reins at Allscripts he had quite a mess on his hands. Previous management had grown the company through a series of acquisitions, but little attention was paid to how these various acquisitions would be stitched together to provide a comprehensive and cohesive EHR that extended from hospitals (acute) to small practices (ambulatory).

Clients were not happy, and Allscripts increasingly lost ground to both Cerner and Epic.

Under Black’s leadership losses have been stemmed, costs brought into alignment, and the bottom line has improved. Today, Allscripts has an acute to ambulatory EHR solution in Sunrise, which now represents roughly half of Allscripts’ annual revenue.

The company has also continued its acquisition strategy, picking up two other EHR platforms –  McKesson’s EIS business (see our original take here) and Practice Fusion. While hearing little about Practice Fusion at this event – after all it was focused on Allscripts’s acute clients – we did hear from a number of former McKesson (Paragon) clients that they were quite happy to have Allscripts as their new parent. As one Paragon customer told me:

“We have been ignored for years. McKesson failed to address known problems with their software. At least now we have a voice and Allscripts is making progress.”

In another session with two Allscripts customers, each related their thorough evaluation and due diligence research of current acute care EHR solutions. Their conclusion: The EHR has become a commodity with comparable functionality across all major aspects that were important to them. Since EHR software is no longer a key differentiator, the relationship with the vendor and the need to minimize disruption to frontline users of the software become paramount. This is likely true across the industry and why the long purported EHR replacement market never materialized.

The EHR has become a commodity with comparable functionality across all major aspects that were important to them. Since EHR software is no longer a key differentiator, the relationship with the vendor and the need to minimize disruption to frontline users of the software become paramount.

Stabilization Done – Now Innovate

In a brief conversation with Black, he was passionate in stating that he wants this company to be seen as the true innovator of the big three EHR vendors. He pointed to their precision medicine efforts with 2bPrecise, a young company started by the founders of HIE vendor dbMotion, a company Allscripts had acquired several years ago.

2bPrecise is now embedded within EHR Sunrise workflow and the company is working with six beta customers, including the Mayo Clinic. Today, Allscripts is the only EHR company that offers the physician the ability to match medication treatment protocols with a patient’s genomic information (e.g., how well a patient can metabolize a given medication) – pretty futuristic and promising work. But there is a fly in the ointment: who pays for this second order derivative to define patient-medication matching? No clear answers yet, though the move to value-based care (capitation) may provide accelerated adoption for certain, complicated diseases (behavioral health, cancer, etc.).

Another innovation they announced at ACE was allowing clinicians from within Sunrise to directly order (prescribe) a Lyft ride for a patient (original partnership announced in March). The use cases for such are numerous, from setting up an appointment (25% of low-income patients cite transportation as a leading cause of missed appointments) to taking a patient home upon discharge. Nice feature for both clinicians and patients.

The company has also been quite progressive on the patient engagement front, first with its vendor agnostic patient portal – FollowMyHealth and its recent acquisition of HealthGrid, a patient engagement tool based on texting.

Lastly, the company is in the process to move its core portfolio of products to a common client user interface (UI) based on progressive web architecture. This effort is in conjunction with their move to hosting their solutions on Microsoft’s Azure platform. Note: the move to hosted cloud services has taken the healthcare IT sector by storm. Three years ago, few CIOs were willing to go “off-prem.” Today, there is literally a tsunami of interest among CIOs looking to off-load the care and feeding of their EHRs and other applications.

Challenges Remain

The EHR market is dead in the U.S. To grow, one must either acquire other EHR vendors and leverage their maintenance revenues aggressively while cutting SG&A costs or look to the next generation of solutions and services the client base will need.

Allscripts has done a little of both but what concerns me most is their lack of a clear and compelling solution suite to support the migration to value-based care. Their messaging around population health (CareInMotion) was generic and this solution suite to support value-based care modalities still lags competing solutions. They are working to rectify these shortcomings, but they are slow in coming.

Their analytics story, quite surprisingly, was nowhere in evidence – little discussion during the sessions I attended nor highlighted in their product pavilion. Contrasting this with what I experienced this past week at Cerner’s own user conference, CHC, or at Epic’s UGM in late August, was striking.

The innovative efforts at Allscripts are heartening, especially those regarding patient engagement. Yet these efforts will not keep the lights on for most healthcare organizations as we migrate to data-driven care delivery models. The industry migration of clinical care from an art (little to no data) to a science (data-driven) is readily apparent – Allscripts’ own story on this, however, is currently not quite as clear.

Stay up to the minute.

Did You Know?

Top 7 Things to Look for at HIMSS17

imagesThe final countdown has begun. In a few short days I and the rest of the Chilmark Research team will make our annual pilgrimage to the big health IT confab, HIMSS17, to rub shoulders with some 45,000 of our closest friends.

I have a love-hate relationship with this event. I love the opportunity to meet with many leading advocates, innovators, developers, and users of IT who are all truly trying to improve the delivery of care – to improve the patient experience. This is my/our tribe. These individuals and even organizations are who we as analysts seek out, looking to have an in-depth conversation. These conversations are enlightening, help us further refine our research agenda, and provide us the opportunity to accurately report on exactly what is working and, frankly, what may still be more vaporware than software.

HIMSS is not all sweet-smelling roses. What frustrates me the most is the hype. Now I know that vendors pay a pretty penny to exhibit their wares at HIMSS and, having been on the other side of the fence, I know intimately the challenges of trying to differentiate yourself from all the others that surround you. But what I truly hate is when the latest fad or buzzword enters the hype-cycle and every single vendor claims to have that solution, to address that buzzword du jour.

Years ago I remember walking by booth after booth of vendors claiming they had a Health Information Exchange (HIE) solution. When I saw such proudly displayed in the Dell booth, I knew it was all BS and decided to separate the wheat from the chaff with our first report on the HIE market. That report was a huge success and really put wind in the sales of what was then a very small company. In recent years it has been population health management (PHM), a misnomer if there ever was one. Until the last 12-18 months, not a single vendor has been capable of fully supporting an organization’s PHM strategy. There are simply too many moving parts to PHM. Simplistic care gap analysis with robo-emails and calls is not PHM. The sad thing is, these buzzwords get so over-used, so misconstrued, and so abused that they become meaningless – I’m coming close to detesting the term PHM.

Enough of a preamble. The following is what I will be on the lookout for at HIMSS – and you should, too.

1. Artificial intelligence (AI) is big, everywhere, but are we truly seeing traction? This term, along with machine learning and cognitive computing, will be on prominent display at HIMSS17. I would not be surprised if this is the top buzzword at HIMSS this year, but what I really want to know is how AI is actually being used. What are the use cases? Where will it scale first (e.g., consumer, clinician, back-office, radiology…)? What impact will it have on existing processes and workflows? How will it impact staffing levels?

2. Precision medicine: Is it real or still theoretical? There’s been a lot of hype on precision medicine the last couple of years but little action. Will be interested to learn how much traction some of the early innovators are getting (NantHealth) and what new entrants (2bPrecise) are planning. Tremendous amount of opportunity here that overlaps some of the current work being done in AI – how will these two come together in the future to improve and optimize the delivery of care for the individual?

3. How will care management and patient engagement merge – who is thinking beyond silos here? A core tenet to effective care management is patient activation and self-care, yet care management and patient engagement solutions remain by and large completely divorced from one another. Who among vendors, providers, and consultants is truly thinking beyond silos and looking to effectively meld care management and patient engagement?

4. Who is using IoT and PGHD at scale? Despite all the talk of health Internet of things (IoT) and patient generated health data (PGHD), our research to date has yet to find an organization that is using IoT and PGHD at scale for remote care monitoring. Sure, there are plenty of pilots, but as one healthcare executive said to me: Its one thing to do such for 100 patients, quite another for 10,000 – we’ve yet to figure out how to scale the workflow across the enterprise and community.

5. Outcome measures, anyone? The focus of quality initiatives (and measures) for years has been on process measures. We are getting to a level of maturity in the industry’s use of IT that we need to be thinking beyond process measures to outcome measures. In a recent briefing, a leading HIT vendor proudly showed how its clients excel at meeting process measures. When asked how these same clients do on outcome measures – well, that was a question the company had no answer for. It’s time we start figuring this out. I want to know who is doing this on a routine basis and for what use cases.

Provider+Payer+risk copy6. How are vendors looking to support PHM and VBC? Core to our research in 2017 is gaining a better understanding of provider-payer convergence. Our thesis is that providers have a core competency in population health management (PHM), whereas payers have competency in value-based care (VBC). As these two entities increasingly collaborate to improve access and care delivery within a community, how will vendors provide a platform to support such requirements?

7. What’s next? a.k.a., reading the Trump administration tea leaves and what may unfold across the healthcare sector over the next few years. The new administration has made a lot of pronouncements pertaining to healthcare, from pharmaceutical pricing to repealing the Affordable Care Act. We still do not know how all this will play out, and that lack of clarity is likely to impact budgets. I want to know: How big is that impact and how might it impact IT spend going forward? While I can already imagine every vendor telling me that it has a great pipeline, a great backlog, etc., I remain unconvinced. I’ll be digging deep on this one.